This blog is the first in a series that looks at the story behind each of the 12 priorities in Start Well, Live Better, FPH’s Manifesto for the 2015 General Election. The Transatlantic Trade and Investment Partnership (TTIP) could impact on one of the 12 priorities: the ability of a UK government to provide a universal healthcare system, free at the the point of delivery.

John Middleton

Vice President for Policy,

United Kingdom Faculty of Public Health

The Faculty of Public Health is concerned about the damaging potential of the Transatlantic Trade and Investment Partnership (TTIP) for public health, environmental protection and sustainability.

TTIP is being touted as a major benefit for trade between the European Union and America. But the means by which greater trade is to be gained is through deregulation of standards of health and safety, standards in consumer safety, environmental, and public protection.

The deal is also likely to further add to global warming and climate change. Alongside the TTIP is a secretive and disturbing quasi-legal instrument known as the Investor State Dispute Resolution scheme (ISDS). This process enables investors to sue governments if they believe their right to profits are being damaged by national policies which may be promoting health, or protecting workers or environments. The proceedings of ISDS are already evident around the world and should be a concern to all those working for better public health and the environment.

A lot has been written about the TTIP and its implications for the NHS. Trade unions, politicians, the Royal Colleges and the Lancet have voiced concerns and called for NHS services to be exempted from the trade agreement. UK government ministers have not shown any inclination to ask for the NHS to be exempted from the agreement, which would be in their powers to ask for. Why would they? When the stated objectives of the Health and Social Care Act 2012 were to open up competition in the health service? Bizarrely, they have also implied that TTIP will offer a competitive edge for the NHS – a great service that should somehow play on the world stage, subsidised by the taxpayer. We are short of midwives in the UK so how we would sell such services to the US or Europe is a mystery.

European commissioners have issued reassuring statements that the NHS will be exempt. But EC commissioners cannot give such assurances. Once the TTIP is signed and provisions for the Investor State Dispute Resolution (ISDS) are in place these are legal agreements for which grievances and claims for compensation can be pursued in a quasi-court.

Any company with a stake in the NHS now could easily cry foul, take recourse to the dispute scheme and claim compensation if their NHS pickings are not to be protected indefinitely.

TTIP and the ISDS are secretive, policed by a few international lawyers, in a self-serving arrangement, using their knowledge and expertise as the arbitrators, or the advocates. The process, rides rough shod over national law, undermining the entitlement of states to legislate for the improved public health and protection of their citizens.

TTIP presents a much bigger threat to the public’s health, much bigger even than the potentially devastating impact on the NHS, TTIP threatens health and safety conditions, hard-earned workers rights, terms and conditions and protection in employment and threatens local and global environmental safety and controls, carbon emissions and global warming. It also threatens to dumb-down consumer safety standards – for example through raising permitted levels of antibiotics in foods.

FPH’s manifesto for all the political parties in the next election includes major recommendations for laws designed to protect and improve the public’s health. A sugar tax, minimum unit pricing of alcohol, a living wage, and reducing carbon emissions – all of these proposals could fall foul of TTIP and its ISDS. If a future government chose say, to accept the overwhelming international and national evidence and implement a minimum unit pricing of alcohol, The Big Alcohol companies could well demand compensation for lost profits, likewise Big Food, on a sugar tax.

It’s easy also to see the ‘chillers effect’ making governments think twice even about implementing such legislation. Multinational companies demand complete freedom to sell their goods whatever the consequences to society. In the case of alcohol, governments pick up the cost of policing violence, and treating disease; other private and public employers pay the costs of alcohol in workplace inefficiency and absenteeism. Big Alcohol pockets the profit.

Strong intellectual property protections afforded under TTIP to pharmaceutical companies may dangerously increase the sphere of influence of big pharma over national regulatory standards. The sovereign power to promote access to medicines and EU transparency requirements over clinical data is at risk.

Supporters of the TTIP quote Obama’s promise of an average $680 per household benefit from the trade agreement. Even if this figure is correct and we take it at face value, would it be a gain worth having? $13 a week gained per household set against potential losses of salary, jobs and working conditions, and the environmental damage of extra consumption for our children to cope with?

And of course, past evidence of major economic change suggests benefits are not delivered equally. There will be big winners and therefore big losers. The narrow margin of benefit is such that gains for bankers, investors, and industrialists will mean loss of money and jobs for many, and destitution heaped on the poor.

Trends towards widening inequalities in income over 40 years in the UK and other parts of the world have been accompanied by widening gaps in the ill health and life expectancy between rich and poor. In 35 years since the Black report, Whitehead, Acheson, Wilkinson and Marmot have all expanded this overwhelming body of knowledge.

Economic inequality causes health inequalities; poverty kills. We can expect widening inequality in health if this trade agreement is signed.

Supporters of the agreement also suggest fears of over use of the ISDS are also unfounded. However, there are recent examples of investor-state disputes which threaten health and the environment which suggest that recourse to these processes is likely to become more common and more damaging to sovereign government’s attempts to legislate for health and the environment. These were illustrated in the New Scientist

The most visible at present is the Phillip Morris Uruguay case where the Marlboro man is asking for compensation for lost earnings as Uruguay prepares the most severe health warnings on packs in the world. Surprising perhaps that a tobacco company now says this public health measure will work and will hit them in the pocket when they have denied such measures will be effective throughout the history of tobacco control. Swedish energy giant Vattenfall is taking Germany to the arbitration tribunal for its decision to move away from nuclear power following the Fukushima disaster.

Lone Pine, the multinational oil and mining company, is suing the Quebec government for $250m over their decision to place a moratorium on fracking. Occidental was recently awarded over $1.7 billion compensation following their eviction from Ecuador, despite having broken Ecuadorian laws. Achmea, the Dutch health insurance company sued Slovakia for the change of health service policy, which required health insurers to operate on a non-profit basis. Veolia is suing the Egyptian government for raising the minimum wage of water treatment workers.

The potential benefits of TTIP for the UK are projected to be in pharmaceuticals, the motor industry and chemicals- in any objective sense, in the context of global warming, these are all industries we need less of – to protect our environment, to stop poisoning people and, increasingly in the era of big pharmacy, to stop damaging our health.

None of these industries are now major job creators per given investment and could only increase at the margins. None of these have any credibility in terms of social and corporate responsibility. The whole idea that economic growth for its own sake is a good thing now needs to be seriously challenged. GDP does not buy us happiness. We need a more sustainable people-centred economy, which supports localism. The very businesses to be sacrificed in this deal are the so-called American ‘mom and pop’ businesses; the main proponents of this deal are the multinationals. Living within our means in order to protect our children’s future is the new imperative.

For all these reasons, it is right that there is a growing disquiet about this sinister and clandestine negotiation. FPH believes it will damage health, create poverty and damage the environment now and in the future. It will make prospects for laws to protect and promote the public’s health far less likely to happen in the future.

If you are not an advocate for this agreement, it is unlikely the benefits will be coming your way. It is likely to benefit only a very small proportion of people in the upper echelons of societies on either side of the Atlantic, or in far off tax havens. If you are not for it, you should be against it. Anybody who is not heading a big multinational company should reject it and campaign vigorously to ensure it never becomes a reality.

Disclaimer

The aim of this blog is to encourage discussion and debate on public health issues. The views expressed here are the personal views of authors, and the content does not reflect the official position of the Faculty of Public Health. However, discussion generated here may be used to influence the development of organisational policy.